Why Torontonians without a family doctor miss out on mental health care
Photo by Dominic Bugatto from the Torontoist Flickr Pool.
For nearly seven years, Kate Spencer didn’t have a family doctor. She had her medical needs met the way more than half of the population without a doctor does, according to a Canadian Community Health Survey in 2014: by utilizing walk-in and specialty health care clinics. It wasn’t until she required mental health care that she finally had to track down a general practitioner to call her own.
“It’s the referrals,” the 26-year-old explains on a sunny day in David Pecaut Square. “[With] my insurance coverage, if you want to go to a psychiatrist or a massage therapist or a few others, you need to have a referral in order to be [reimbursed].”
For many Canadians, a family doctor is the first point of contact for medical care. As noted by the Mental Health Commission of Canada, people are more likely to consult their family physician about a mental health problem or illness than any other health care provider. Yet, the 2014 Canadian Community Health Survey reports, 7.5 per cent of the province’s population is without a regular doctor (the country as a whole fares even worse—14.9 per cent of Canadians are without one). Not having a family physician is associated with fewer visits to general practitioners or specialists, who play an important role in mental health treatment.
Though Spencer briefly saw a family doctor long enough to get a referral to a psychiatrist, the relationship didn’t stick. “I just hated this woman so much that I went twice and never went back,” she admits.
Other reasons for not having a family doctor, according to the 2014 health survey, include previous doctors moving or retiring, doctors in the area not taking new patients, limited physician availability, or, most commonly, a family doctor simply hasn’t been sought out.
While Spencer was able to access a psychiatrist for counselling through a family doctor, her coverage quickly ran out, resulting in fragmented and inconsistent treatment. “I’ve had two times now where I’ve gone to the psychiatrist and had insurance money, ran through it, and then just not gone back,” she says.
Barrier-free care
Spencer, like many of the Torontoians I talked to, was unaware of no-cost counselling options in the city. Community-based mental health treatment, according to a 2004 report released by the Canadian Mental Health Association, can be up to five times less expensive than hospital-based care and is typically far more accessible than other options. There are a number of walk-in counselling clinics around the city that offer weekly hours, do not require a referral, and have very few access restrictions. Evidence from a 1996 paper prepared by the Canadian Psychiatric Association also suggests that those with psychiatric problems might receive better health care in special mental health settings than primary care.
For those struggling to find accessible counselling in the city, we’ve included a round up of barrier-free mental health walk-in clinics.
WoodGreen Community Services, a social service agency funded by the non-profit WoodGreen Foundation, offers a host of community supports including walk-in counselling hours from 4 to 8 p.m. every Wednesday at its Danforth location. Its counselling service requires no appointment or referral, and has no restrictions to access. Interested clients can address a variety of issues including depression, anxiety, anger issues, and parenting concerns, and are welcome to return for subsequent sessions. WoodGreen facilitates access to long-term mental health care either through its no-cost counselling programs for those who fall inside the catchment area, or through its host of other social service programs.
Family Service Toronto, a non-profit offering counselling, community development, and public education programs, also provides walk-in counselling sessions. Its focus is also on accessibility of mental health care resources, though the clinic doesn’t provide treatment to those under 18. Walk-in counselling hours are every Wednesday from 3:30 to 7:30 p.m. at the Sterling Road location. Though the focus is on single-session counselling, Family Service Toronto also offers long-term counselling on a sliding-scale fee model based on household income.
For youth seeking mental health treatment, CAMH has recently partnered with Scarborough’s East Metro Youth Services, Delislie Youth Services, and the South East Toronto Family Health Team to launch its “What’s Up” walk-in clinic. These clinics are geared to youth aged 11 to 25 offering a range of services including solution-focused therapy, peer support, system navigation, and onsite access to psychiatric services. These free clinics have varying hours dependent on location.
Oolagen, a not-for-profit children’s mental health agency and teaching facility, also hosts a “What’s Up” walk-in clinic for youth through its partnership with East Metro Youth Services.